Changing building user attitude and organisational policy towards sustainable resource use in healthcare

Health care provision is significantly impacted by the ability of the health providers to engineer a viable healthcare space to support care stakeholders needs. In this paper we discuss and propose use of organisational semiotics as a set of methods to link stakeholders to systems, which allows us to capture clinician activity, information transfer, and building use; which in tern allows us to define the value of specific systems in the care environment to specific stakeholders and the dependence between systems in a care space. We suggest use of a semantically enhanced building information model (BIM) to support the linking of clinician activity to the physical resource objects and space; and facilitate the capture of quantifiable data, over time, concerning resource use by key stakeholders. Finally we argue for the inclusion of appropriate stakeholder feedback and persuasive mechanism, to incentivise building user behaviour to support organisational level sustainability policy.

Pragmatic oriented data interoperability for smart healthcare information systems

Smart healthcare is a complex domain for systems integration due to human and technical factors and heterogeneous data sources involved. As a part of smart city, it is such a complex area where clinical functions require smartness of multi-systems collaborations for effective communications among departments, and radiology is one of the areas highly relies on intelligent information integration and communication. Therefore, it faces many challenges regarding integration and its interoperability such as information collision, heterogeneous data sources, policy obstacles, and procedure mismanagement. The purpose of this study is to conduct an analysis of data, semantic, and pragmatic interoperability of systems integration in radiology department, and to develop a pragmatic interoperability framework for guiding the integration. We select an on-going project at a local hospital for undertaking our case study. The project is to achieve data sharing and interoperability among Radiology Information Systems (RIS), Electronic Patient Record (EPR), and Picture Archiving and Communication Systems (PACS). Qualitative data collection and analysis methods are used. The data sources consisted of documentation including publications and internal working papers, one year of non-participant observations and 37 interviews with radiologists, clinicians, directors of IT services, referring clinicians, radiographers, receptionists and secretary. We identified four primary phases of data analysis process for the case study: requirements and barriers identification, integration approach, interoperability measurements, and knowledge foundations. Each phase is discussed and supported by qualitative data. Through the analysis we also develop a pragmatic interoperability framework that summaries the empirical findings and proposes recommendations for guiding the integration in the radiology context.

Looking in the wrong place for healthcare improvements: a system dynamics study of an accident and emergency department

Accident and Emergency (A&E) units provide a route for patients requiring urgent admission to acute hospitals. Public concern over long waiting times for admissions motivated this study, whose aim is to explore the factors which contribute to such delays. The paper discusses the formulation and calibration of a system dynamics model of the interaction of demand pattern, A&E resource deployment, other hospital processes and bed numbers; and the outputs of policy analysis runs of the model which vary a number of the key parameters. Two significant findings have policy implications. One is that while some delays to patients are unavoidable, reductions can be achieved by selective augmentation of resources within, and relating to, the A&E unit. The second is that reductions in bed numbers do not increase waiting times for emergency admissions, their effect instead being to increase sharply the number of cancellations of admissions for elective surgery. This suggests that basing A&E policy solely on any single criterion will merely succeed in transferring the effects of a resource deficit to a different patient group.

Cultural policy and cultural politics in Revolutionary Cuba: re-reading the 'Palabras a los intelectuales' (Words to the Intellectuals)

This article re-reads Fidel Castro's speech to Cuban artists and intellectuals at the Biblioteca Nacional José Martí (National Library) in June 1961. Despite extensive discussion of its famous extract, the speech has rarely been examined in depth. This article thus analyses the entire speech, situating it within its co-text and its context and examining its multiple functions, offering as it does an insight into the social and educational implications of cultural revolution in Cuba and the inevitable tensions inherent in these. The article evaluates the negotiations in the text in the light of their relevance to contemporary cultural debates in Cuba.

Cultural policy, literature and readership in revolutionary Cuba: the view from the 21st century

This article presents a fresh perspective on cultural policy in revolutionary Cuba, focusing specifically on the centrality of dialogue with the general readership to the production, reception and regulation of literature. It first summarises the positions regarding revolutionary literature that have been asserted and essayed at various points along the sometimes chaotic trajectory of revolution in Cuba. It then examines reading-related policies and recent attempts within Cuba to re-orient reading practices in the aftermath of the Período Especial [Special Period], and ends by presenting current Cuban debates on the need to mitigate dialogic breakdown between literary text and readership.